Contributions
Abstract: EP1044
Type: E-Poster Presentation
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Complete remission (CR) is an important prognostic factor for overall survival (OS) in Multiple Myeloma (MM). The prognostic significance of sustained partial response (sPR) defined as PR >24 months, however, may be a sufficient goal in MM patients, ineligible for transplant (NTE). The characteristics of NTE MM patients who achieve sPR and its prognostic role has not been sufficiently explored.
Aims
Herein, we investigated the characteristics, the prognostic impact and OS rates of NTE patients achieving sPR, compared with those who achieve CR after induction therapy.
Methods
We studied 255 patients (M/F: 130/125, median age: 68, range: 43-83, IgG: 151. IgA: 64, light chain: 31, non-secretory: 9), who were considered eligible for analysis among 487 consecutive NTE MM diagnosed and treated in our department between 2001-2019; 62 fulfilled the criteria of sPR whereas the rest (n=193) achieved CR after induction treatment. Importantly, patients in CR were considered as eligible for analysis if OS exceeded 24 months. The 2 groups were compared for standard prognostic factors such as age, International Staging System (ISS) and revised ISS (RISS), β2 microglobulin (β2Μ), lactate dehydrogenase (LDH), hemoglobin (Hb) and estimated glomerular filtration rate (eGFR). Comparisons were performed with Pearson’s x2 test, Mann-Whitney-U-test and One-Way ANOVA. Prognostic factors for the type of response (sPR vs. CR) were evaluated with binary logistic regression analysis; OS was plotted with Kaplan-Meier; p<0.05 was considered as statistically significant boundary.
Results
Median age at diagnosis was higher in the sPR group. Patients with sPR had better performance status, higher eGFR and less often anemia, abnormal LDH, and advanced stage (ISS3/RISS3) at diagnosis (p<0.05). With regard to molecular cytogenetics overall, high-risk features were less common in the sPR group (p<0.05); in particular, t(4;14) was not detected in any patient with sPR vs. 10% in the CR group, whereas del17p was found in 2% of patients with sPR vs. 14% in the CR group (p<0.05); the rate of t(14;16) or 1q+ did not differ between groups (p>0.05); 71% of patients with sPR was treated upfront with novel agents compared with 24% of those in the CR group (p<0.05). Overall, 65% of the studied population received 2nd line therapy (sPR vs. CR group: 51% vs. 69%; p<0.05). Age >65, RISS1/2 and absence of anemia (Hb<10g/dL) were independent predictors for achieving sPR vs. CR (p<0.05). In the univariate analysis for OS, established markers such as ISS, RISS and LDH confirmed their prognostic value for the whole study population (p<0.05). In addition, type of response (sPR vs. CR) was an independent prognostic factor for OS after adjustment for the type of initial therapy (HR: 0.59; p=0.009). Patients who achieved sPR exhibited significantly longer OS compared with those achieving CR (84 months vs. 59 months; p=0.008). In the multivariate analysis, RISS was the strongest prognostic factor for OS (HR: 0.32; p=0.002).
Conclusion
Patients who achieve sPR represent a unique group of NTE MM patients with higher age and favorable prognostic characteristics. Achievement of sPR was a positive prognostic factor for OS, which led to 41% reduction of the risk of death; this latter finding supports that probably in a subgroup of NTE MM patients with favorable features, therapeutic strategy should not always aim for CR, at the expense of safety and quality of life.
Keyword(s): Myeloma, Outcome, Prognostic factor
Abstract: EP1044
Type: E-Poster Presentation
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Complete remission (CR) is an important prognostic factor for overall survival (OS) in Multiple Myeloma (MM). The prognostic significance of sustained partial response (sPR) defined as PR >24 months, however, may be a sufficient goal in MM patients, ineligible for transplant (NTE). The characteristics of NTE MM patients who achieve sPR and its prognostic role has not been sufficiently explored.
Aims
Herein, we investigated the characteristics, the prognostic impact and OS rates of NTE patients achieving sPR, compared with those who achieve CR after induction therapy.
Methods
We studied 255 patients (M/F: 130/125, median age: 68, range: 43-83, IgG: 151. IgA: 64, light chain: 31, non-secretory: 9), who were considered eligible for analysis among 487 consecutive NTE MM diagnosed and treated in our department between 2001-2019; 62 fulfilled the criteria of sPR whereas the rest (n=193) achieved CR after induction treatment. Importantly, patients in CR were considered as eligible for analysis if OS exceeded 24 months. The 2 groups were compared for standard prognostic factors such as age, International Staging System (ISS) and revised ISS (RISS), β2 microglobulin (β2Μ), lactate dehydrogenase (LDH), hemoglobin (Hb) and estimated glomerular filtration rate (eGFR). Comparisons were performed with Pearson’s x2 test, Mann-Whitney-U-test and One-Way ANOVA. Prognostic factors for the type of response (sPR vs. CR) were evaluated with binary logistic regression analysis; OS was plotted with Kaplan-Meier; p<0.05 was considered as statistically significant boundary.
Results
Median age at diagnosis was higher in the sPR group. Patients with sPR had better performance status, higher eGFR and less often anemia, abnormal LDH, and advanced stage (ISS3/RISS3) at diagnosis (p<0.05). With regard to molecular cytogenetics overall, high-risk features were less common in the sPR group (p<0.05); in particular, t(4;14) was not detected in any patient with sPR vs. 10% in the CR group, whereas del17p was found in 2% of patients with sPR vs. 14% in the CR group (p<0.05); the rate of t(14;16) or 1q+ did not differ between groups (p>0.05); 71% of patients with sPR was treated upfront with novel agents compared with 24% of those in the CR group (p<0.05). Overall, 65% of the studied population received 2nd line therapy (sPR vs. CR group: 51% vs. 69%; p<0.05). Age >65, RISS1/2 and absence of anemia (Hb<10g/dL) were independent predictors for achieving sPR vs. CR (p<0.05). In the univariate analysis for OS, established markers such as ISS, RISS and LDH confirmed their prognostic value for the whole study population (p<0.05). In addition, type of response (sPR vs. CR) was an independent prognostic factor for OS after adjustment for the type of initial therapy (HR: 0.59; p=0.009). Patients who achieved sPR exhibited significantly longer OS compared with those achieving CR (84 months vs. 59 months; p=0.008). In the multivariate analysis, RISS was the strongest prognostic factor for OS (HR: 0.32; p=0.002).
Conclusion
Patients who achieve sPR represent a unique group of NTE MM patients with higher age and favorable prognostic characteristics. Achievement of sPR was a positive prognostic factor for OS, which led to 41% reduction of the risk of death; this latter finding supports that probably in a subgroup of NTE MM patients with favorable features, therapeutic strategy should not always aim for CR, at the expense of safety and quality of life.
Keyword(s): Myeloma, Outcome, Prognostic factor